If you have not seen it already, you might find the following item of interest:
hindawi.com/journals/mi/201...
The subject is MPNs as inflammatory diseases. If I have understood correctly (a big IF), the authors believe there is now convincing evidence that MPNs are the result of a vicious circle in which genetic mutations lead to dysregulated and damaging inflammation, causing in turn more genetic mutations and more damaging inflammation and so on. These underlying processes may drive disease progression from ET to PV to MF and beyond, as well as promoting co-morbidities.
The authors seem to be calling for a revolution in the treatment of MPNs, in which there would be a proactive attempt to tackle the underlying disease processes, with a view to slowing them down or stopping them or even reversing them, rather than passively treating only the symptoms caused by them. This might entail, from the earliest stages soon after diagnosis of ET or PV, the use of medications such as Interferon, Janus Kinase inhibitors (eg: Ruxolitinib), even statins, rather than (for example) Aspirin and Hydroxycarbamide/Hydroxyurea. The hope would be that early intervention would prevent disease progression and leave behind a stable and manageable disease burden; life would be extended and quality of life improved.
The review dates from 2015 but 5 years is quite a long time in this rapidly developing field. I know that some MPNers on this forum are in touch with, or being treated by, leading specialists in the field. Do you get the impression that such a treatment revolution is now happening, or are the ideas expressed in the article still controversial?
In a publicly funded health system such as the UK NHS, I suspect that cost considerations must play a part. I would guess that even low-dose Interferon + Ruxolitinib would cost a lot more than Aspirin + Hydroxycarbamide ... Also, given that MPNs are often diagnosed relatively late in life and may, even with current treatments, not shorten lifespan significantly, there would be a preference for putting funds into diseases that start earlier and are more immediately life-threatening. However, advances in the understanding and treatment of MPNs are likely to be of wider benefit, as the underlying inflammatory disease processes are probably relevant in many other illnesses too.
I would be interested to see what fellow MPNers think about all of this ...
Thank you for reading this far!